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The Economic Benefits of and Access to

Updated February, 2020 Until the 1965 Supreme Court decision in Griswold v. Connecticut, access to birth control was heavily restricted or banned—even for married —in many states. It wasn't until 1972 that birth control became legal for all women in the regardless of marital status.1 The expansion in access to reliable birth control in the second half of the greatly improved the economic status of women. By enabling women to better determine when or if they have children, oral contraceptives and other methods of reliable birth control have advanced women’s economic empowerment and improved health outcomes for mothers and their children. The benefits of family planning underscore the importance of ensuring that Americans have access to affordable, reliable birth control methods.

Fewer Unwanted The rate of unplanned pregnancies has dropped precipitously in the last 40 years.  In 2011, the unplanned rate was 45 per 1,000 pregnancies, the lowest rate since at least 1981 when the rate was nearly 60.2 Between 2008 and 2011 alone the rate dropped 18%.3 Studies suggest the decline is likely due to an overall increase in contraceptive use and effectiveness of contraceptive methods.  The rate of in the United States dropped from almost 118 pregnancies per 1,000 women aged 15-19 in 1990 to a record low 19 per 1,000 in 2017.4 Much of the recent decline is attributable to the rapid expansion of available contraceptive methods that occurred since 1990.5  A 2010 study found that publicly funded contraceptive care resulted in a reduction of approximately one million unplanned births in that year.6 Researchers estimate that over 150,000 would have been premature, low or both, while 300,000 would have been closely spaced, which studies have linked to increased risks of maternal and and other adverse outcomes.7

Expanded Educational Opportunities Control over the timing of childbearing gives women more choices to pursue higher and professional careers.  In 1970, just five years after birth control was made legal for married couples, some states had reduced the age of access to birth control from 21 to 18 while other states did not. Research suggests that access to birth control at an earlier age improves economic outcomes for women, such as increases in educational attainment and labor force participation. One study found that college enrollment was 20 percent higher for women who had legal access to birth control than for those who did not.8 Women with earlier birth control access were also less likely to leave school before earning their degree.  The number of women pursuing professional education spiked after the landmark Supreme Court cases that made birth control legal and accessible. Women made up less than five percent of first-year law and business school classes in the 1960s, and the share increased more than ten times to around 57 percent and 39 percent by 1980 for law and business respectively. In medical schools, the share roughly tripled during that period, from 10 percent to 42 percent.9  Today, women make up more than half of both law school and medical school students, while business schools fall short of 40%.10 For example, when Justice Ruth Bader Ginsburg was a student at Harvard Law School in 1957, she was one of nine women in a class of over 500 men. Today, she would be in the company of nearly 300 women.11

4% of first-year law students were 54% of first-year law students were women in 1963-64 women in 2019-20

Men Women Men Women Source: ABA Law School Data Source: ABA Law School Data

Higher Income Women with early access to birth control experience higher lifetime earnings.  Researchers point to the resurgence of the women’s movement, the Civil Rights Act of 1964 and the availability of oral contraceptives, the most used method of contraception, as the main causal roots for the narrowing of the gender pay gap.12 According to one study, access to birth control pills is responsible for roughly one-third of the total wage gains women have made since the 1960s.13

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 Increased access to oral contraceptives can even increase women’s earnings after their reproductive years. One study estimates that since birth control became available in the 1960s, access to birth control pills at a younger age “conferred an 8 percent hourly wage premium by age 50.”14  Increased access to birth control can also reduce female . One study found that “having legal access to the birth control pill by age 20 significantly reduces the probability that a woman is subsequently in poverty.”15  Another study found that “legal access to the pill before age 21 significantly reduced the likelihood of a first birth before age 22, increased the number of women in the paid labor force, and raised the number of annual hours worked.”16

Better Outcomes for Children Contraception is linked to improved maternal and health outcomes by enabling women to plan, delay and space pregnancies.  Family planning programs reduce the likelihood of children living in poverty, the share of children living in households receiving welfare payments and the share of children living in single-parent households. Research shows that increased access to federally-funded family planning programs is associated with large reductions in child poverty rates and in later poverty rates in adulthood.17  The children of women who have access to family planning are more likely to have higher educational attainment.18 Given the well-known links between higher educational attainment and higher wages, these children also appear to have higher lifetime incomes.

Private and Public Cost Savings Removing barriers to contraception helps alleviate the costs of contraceptives, which are disproportionally borne by women, and preventing unplanned pregnancies saves taxpayer dollars.  The year after the (ACA) went into effect in 2012, women saved $483 million on birth control pills due to the provision ensuring zero out-of-pocket costs for contraceptives.19  For the 60% the 61 million U.S. women of reproductive age use a contraceptive method. For women using contraceptives, average annual savings were $248 for the and $255 for the in 2013.20  A 2014 study found that preventing unplanned pregnancies and their associated costs comprised the biggest share of government cost savings: $15.2 billion saved on Medicaid-covered maternity and infant care and on publicly funded medical care for

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children aged 13 to 60 months; $409 million saved on Medicaid-covered care for ; $44 million saved for care.21

Privately insured women are increasingly paying $0 out- of-pocket for contraception since the ACA 80% 74% 70% 67%

pocket 62%

- 59% of

- 60%

50% 45%

40%

30% 27% 20% 20% 15%

10%

0%

Percent of women payingout$0 Pill Injectable Ring IUD Fall 2012 (just before ACA took effect) Spring 2014 Source: Sonfield, A., Tapales, A., Jones, R. K., & Finer, L. B. (2015). Impact of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update. Contraception, 91(1), 44-48.

1 C, A. (2015). When Contraception Was a Crime: Griswold v. Connecticut. Retrieved from http://advocatesaz.org/2015/06/02/when-contraception-was-a-crime-griswold-v-connecticut/; The Birth Control Pill A History. (2015). Retrieved from https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf 2 Finer, L. B., & Zolna, M. R. (2014). Shifts in intended and unintended pregnancies in the United States, 2001– 2008. American journal of public health, 104(S1), S43-S48. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011100/.; Finer, L. B., & Zolna, M. R. (2016). Declines in in the United States, 2008–2011. New England Journal of Medicine, 374(9), 843-852. Retrieved from https://www.nejm.org/doi/full/10.1056/nejmsa1506575. 3 Ibid. 4 Kost, K., Maddow-Zimet, I., & Arpaia, A. (2017). Pregnancies, births and among adolescents and young women in the United States, 2013: national and state trends by age, race and ethnicity. Retrieved from https://www.guttmacher.org/report/us-adolescent-pregnancy-trends-2013; About Teen Pregnancy (n.d). Retrieved from https://www.cdc.gov/teenpregnancy/about/index.htm 5 Santelli, J. S., Lindberg, L. D., Finer, L. B., & Singh, S. (2007). Explaining recent declines in adolescent pregnancy in the United States: the contribution of and improved contraceptive use. American journal of public health, 97(1), 150-156. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1716232/ 6 Frost, J. J., Sonfield, A., Zolna, M. R., & Finer, L. B. (2014). Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program. The Milbank Quarterly, 92(4), 696- 749. Retrieved from https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/MQ-Frost_1468- 0009.12080.pdf 7 Grundy, E., & Kravdal, Ø. (2014). Do short birth intervals have long-term implications for parental health? Results from analyses of complete cohort Norwegian register data. J Epidemiol Community Health, 68(10), 958-964. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174138/;

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Fotso, J. C., Cleland, J., Mberu, B., Mutua, M., & Elungata, P. (2013). and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system. Journal of biosocial science, 45(6), 779-798. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785173/ 8 Bailey, M. J., Hershbein, B., & Miller, A. R. (2012). The opt-in revolution? Contraception and the gender gap in wages. American Economic Journal: Applied Economics, 4(3), 225-54. Retrieved from https://www.nber.org/papers/w17922.pdf 9 Goldin, C., & Katz, L. F. (2002). The power of the pill: Oral contraceptives and women’s career and decisions. Journal of political Economy, 110(4), 730-770. Retrieved from https://www.nber.org/papers/w7527.pdf 10 2019 1L Enrollment by Gender & Race/Ethnicity. Retrieved from https://www.americanbar.org/groups/legal_education/resources/statistics/; Total Enrollment by U.S. Medical School and Sex, 2014-2015 through 2019-2020. Retrieved from https://www.aamc.org/download/321526/data/factstableb1-2.pdf; The Forté Foundation (2019). Women’s full-time MBA enrollment percentages in the U.S. Fall 2011-2019. Retrieved from http://www.fortefoundation.org/site/DocServer/FORTE_WOMENS_FULL- TIME_MBA_ENROLLMENT_INFOGRAPHIC_2019.pdf?docID=26208 11 Ruth Bader Ginsburg’s Story Will Melt Your Heart. Retrieved from https://www.cnn.com/ampstories/politics/ruth-bader-ginsburgs-love-story-will-melt-your-heart; 2019 1L Enrollment by Gender & Race/Ethnicity. Retrieved from https://www.americanbar.org/groups/legal_education/resources/statistics/ 12 Contraceptive Use in the United States. (2018). Retrieved from https://www.guttmacher.org/fact- sheet/contraceptive-use-united-states 13 Bailey, et al., (2012). Retrieved from https://www.nber.org/papers/w17922.pdf 14 Ibid. 15 Browne, S. P., & LaLumia, S. (2014). The effects of contraception on female poverty. Journal of Policy Analysis and Management, 33(3), 602-622. Retrieved from http://lanfiles.williams.edu/~sl2/Browne_LaLumia_ELA.pdf 16 Bailey, M. J. (2006). More power to the pill: the impact of contraceptive freedom on women's life cycle labor supply. The Quarterly Journal of Economics, 121(1), 289-320. Retrieved from https://www.jstor.org/stable/pdf/25098791.pdf 17 Bailey, M. J., Malkova, O., & Norling, J. (2014). Do family planning programs decrease poverty? Evidence from public census data. CESifo economic studies, 60(2), 312-337. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206087/ 18 Bailey, M. J. (2013). Fifty years of family planning: new evidence on the long-run effects of increasing access to contraception (No. w19493). National Bureau of Economic Research. Retrieved from https://www.brookings.edu/wp-content/uploads/2016/07/2013a_bailey.pdf 19 Aitken, M., Kleinrock, M., Lyle, J., & Caskey, L. (2014). Medicine use and shifting costs of healthcare: a review of the use of medicines in the United States in 2013. IMS Institute for Healthcare Informatics. IMS Health. April. Retrieved from https://oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/IMS- Medicine%20use%20and%20shifting%20cost%20of%20healthcare.pdf 20 Contraceptive Use in the United States. (2018). Retrieved from https://www.guttmacher.org/fact- sheet/contraceptive-use-united-states; Becker, N. V., & Polsky, D. (2015). Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing. Health Affairs, 34(7), 1204-1211. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0127 21 Frost, et al., (2014). Retrieved from https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/MQ- Frost_1468-0009.12080.pdf

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